Atlantic Coast Conference
Football Officiating Application
PERSONAL AND CONFIDENTIAL
Name _______________________________________________________ Date __________________
Home Address _______________________________________________________________________
City _____________________________________ State _______ Zip ___________________
Business Address _____________________________________________________________________
City _____________________________________ State _______ Zip ___________________
Telephone: Home _____________________________ Business _____________________________
Cell _______________________________ Email ____________________________________________
Profession or Occupation ________________________________________________________________
DOB _______________ Height ______ Weight _______ Social Security # ________________________
EDUCATION
Graduate of High School _______________ College _______________ Post-Graduate _______________
Name of High School _______________________________ City _____________________ State ______
Name of College ___________________________________ City _____________________ State ______
Playing Experience in Years: Football H.S. _______ College _______ Other _______
Basketball H.S. _______ College _______ Other _______
___________ H.S. _______ College _______ Other _______
(Specify Other)
OFFICIATING BACKGROUND
(NOTE: 5 years of high school and 5 years of college officiating (at any level) is required to be eligible for consideration on any roster)
Number of years you have worked as an official: H.S. _______ College ________ Pro _______
Do you work, or have you worked, in other collegiate athletic conferences? Yes _______ No ______
If yes, which conference or conferences and when? _______________________________________
_________________________________________________________________________________
Do you officiate high school sports? Yes _____ No _____ Which sports? ______________________
What officials associations are you a member of? _________________________________________
_________________________________________________________________________________
In which capacity do you prefer to work football? 1-Referee, 2-Umpire, 3-Linesman, 4-Line Judge,
5-Field Judge, 6-Back Judge, 7-Side Judge? Please rank in order of preference:
__________________________________________________________________________________
Are there any circumstances or conditions that affect your priority for accepting assignments to work
in the Atlantic Coast Conference? Yes _____ No _____. If yes, please indicate. __________________
__________________________________________________________________________________
Have you participated in professional sports as a player, coach, or official? Yes ______ No ______
If yes, please describe the participation, name of club, etc. ___________________________________
__________________________________________________________________________________
Officiating Schedule: Please attach on a separate sheet of paper, your complete football officiating schedule for the past season.
REFERENCES
Please list the names, addresses and phone numbers of three qualified persons who have observed your work as an official. These people may be contacted as references.
1. ________________________________________________________________________________
2. ________________________________________________________________________________
3. ________________________________________________________________________________
I acknowledge that the above information is correct and true.
Signature: ___________________________________________________________________________
Please sign and return the completed questionnaire to:
Doug Rhoads
ATTN: ACC Football Officiating Application
Atlantic Coast Conference
PO Drawer ACC
Greensboro, NC 27417
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